Patient identity and matching problems are not new to healthcare. But the COVID-19 pandemic has raised the stakes, healthcare leaders say.
The failure to accurately identify patients to their data raises patient safety and quality of care concerns, such as the wrong lab results being attached to a patient's record or patients receiving the wrong medication.
In the current health crisis, mismatched patient records can also hamper public health efforts to respond to the coronavirus and address health inequities.
"COVID-19 highlights the importance of health IT and data and it's more important than ever to solve our country’s patient misidentification problem," said Wylecia Wiggs Harris, M.D., CEO of the American Health Information Management Association (AHIMA), speaking Tuesday during a virtual Capitol Hill briefing.
During the pandemic, there have been issues with COVID-19 test results not accurately matched to the right patients, said Abby Sears, the CEO of OCHIN, a Portland-based nonprofit health care innovation center.
"There were some examples in Washington state with patients that had positive test results and we could not find those patients to ensure they were getting treatment," said Sears. OCHIN works with 20,000 providers to provide technology services and has facilitated the exchange of 114 million patient records since 2010.
Healthcare leaders and health IT groups are calling on Congress to repeal a section of the law that prevents the U.S. Department of Health and Human Services (HHS) from working with the private sector to develop a nationwide patient identification strategy.
The law has created barriers to a public-private sector collaboration that could advance a new patient identification strategy, Harris said.
Many health IT leaders see the investigation and creation of unique patient identifiers as critical to solving issues with patient matching and potentially minimizing misidentification and medical errors.
Patients’ records are often matched based on demographic data, such as names, addresses, or dates of birth. Matching records to the correct person becomes increasingly complicated as organizations share records electronically using different systems. And many regions experience a high number of individuals who share the exact name and birthdate, leading to the need for additional identifying attributes to be used when matching patient records.
A 2014 report from the Office of the National Coordinator for Health Information Technology (ONC) found that 7 out of every 100 patient records are mismatched. Worse still, the error rate is typically closer to 10% to 20% within a healthcare entity, and it rises to 50% to 60% when entities exchange with each other.
In a 2012 CHIME study, 20% of CHIME members could trace an adverse medical event to problems with patient identification and/or patient matching.
The lack of a consistent national strategy to accurately identify patients also exacerbates existing health inequities, Harris said.
Data suggests that low-income individuals and racial minorities are more likely to have chronic illnesses, and failure to accurately identify patients in these communities hinders the industry's ability to deliver the right care to the right patient at the right time in the proper setting, she said.
Minority populations also have a higher rate of mismatched records, according to Sears.
OCHIN works with more than 500 healthcare providers in 47 states. Among its patient population, 13% of patients are Black but represent 21% of mismatched records. While 21% of the patient population is Hispanic, 35% of those patients have been misidentified. About 4% of OCHIN's patient population is homeless, but 12% of those patients have been misidentified, Sears said.
"Every mismatched or duplicate record puts two patients at risk—the person receiving care and the person who was inaccurately mismatched with that patient. This can lead to patients receiving the wrong care, the wrong patient history, the wrong testing, and drug-drug interactions," she said.
Impact on COVID-19 efforts
Amid the COVID-19 pandemic, contact tracing efforts are hampered without accurate demographic information that correctly identifies the right patient.
"We are not able to identify those high-risk areas and we don’t know which record goes back to which patient. It’s a huge safety issue," said Rebecca Way, director of revenue cycle business operations at Northwell Health in New York City.
Any large-scale nationwide vaccination program for COVID-19 also would depend on robust and reliable data, healthcare leaders say.
Although HIPAA initially required the creation of a health identifier in 1998, Congress overruled the legislation, barring federal agencies from investigating or creating patient identifiers out of privacy concerns.
Industry efforts to establish a unique patient identifier in U.S. healthcare hit a roadblock last year.
Despite gaining support in the U.S. House of Representatives, Senate appropriators did not include language overturning the two-decade-old ban on creating unique patient identifiers in the fiscal year 2020 funding bill for HHS.
To push action on the issue, six healthcare organizations—including Intermountain Healthcare—formed a national coalition called Patient ID Now. The coalition is focused on addressing the issue of patient identification by advocating for legislation and regulations.
Other members of the coalition include the American College of Surgeons, AHIMA, the College of Healthcare Information Management Executives (CHIME), the Healthcare Information and Management Systems Society and Premier Healthcare Alliance.
"We think this issue has never been more important and we are hoping to get Congress' attention right now," said Cassie Leonard, director of congressional affairs at CHIME.
Properly matching patients and their data not only improves care but saves resources, according to Patient ID Now.
The Ponemon Institute indicates that on average, 35% of all denied claims result directly from inaccurate patient identification or inaccurate and incomplete patient information, costing the average US healthcare system $1.2 million per year.